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Canadian minds battle to unlock concussion mysteries: Arthur

The slices of brain are so thin that they are barely there, trapped in a glass slide, each one a piece of a very large map. They have splotches of brown splashed through those minds, rotten patches. Some are the brains of retired CFL players; some are people with a less specific history of head trauma. One was an NHL player. His name cannot be revealed because the family has not given consent for that yet. But his brain tells a story.

“It’s the cortex of a young man, in his 30s,” says Dr. Lili-Naz Hazrati, a lead neuropathologist on the Canadian Sport Concussion Project, in her office at Toronto General Hospital, steps away from the autopsy room. “(In life), the man has symptoms, quite debilitating symptoms. He’s not demented, but he used to take photos of things, just to remember. Disturbed, in many ways. And when I looked at the brain, you remember the crowding of the brown stuff?” She frowns. “The only thing I had was this.”

Lamarcus Joyner of the St. Louis Rams loses his helmet during Monday night's game against the 49ers. (Dilip Vishwanat / GETTY IMAGES)

The slide shows dots of tau protein, but only dots, spread apart. Tau is the key element of chronic traumatic encephalopathy, or CTE, the neurological disease that has been linked to brain trauma in football and hockey. In severe cases the tau clusters around neurons and, when stained properly, you can see it leaching throughout a dissected brain.

Here, there are only isolated spots, little ones. No Alzheimer’s, no Parkinson’s, no dementia. Just CTE, clean. That’s hard to find because so many ex-players die later, after their brains have become more complicated.

“What I took away,” says Dr. Hazrati, “was that just a little bit of this can be very bad, for functioning.”

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Dr. Hazrati is working under Dr. Charles Tator, the renowned concussion expert who has assembled a team of 15 doctors and researchers in Toronto. They believe they should be the pre-eminent concussion research centre in Canada. For that, they need more brains to be donated, and to take apart.

“We want 50 brains,” says Dr. Tator, 77. “50 would be a great number . . . I’m in a hurry. You’ve got lots of time. I don’t have lots of time. The long-term goal is not only to diagnose this in life, but to treat it.”

There is no comparison on the numbers. At the brain bank at Boston University, Dr. Ann McKee has examined 128 brains of football players, from high school to the pros, and found CTE in 101 of them, including those of NFL stars Junior Seau and Mike Webster. The Boston group, led by former wrestler Chris Nowinsky, chases brains and publicity, hard. Tator’s group is looking for the brains of ex-CFL players, and is not above asking for them. They advertise in the CFL alumni newsletter.

“We don’t fight over brains with other groups,” says Dr. Hazrati, whose first summer job as a biology student was tracing brain pathways as a 17-year-old in a lab. “I don’t think that’s the right way to do it, anyway.”

Dr. Hazrati and Dr. Tator, however, believe that they have more to offer than the Boston group. The way Dr. Hazrati cuts thinner slices — hers are just six microns wide, which allows her to see how the disease affects individual neurons — is better, they say, than McKee’s comparatively thicker samples. Dr. Hazrati wants to figure out how CTE works, rather than simply identifying it.

“The Boston group has a larger cohort, but they’ve been singing the same song, the same, same, same thing,” says Dr. Hazrati, who was born in Iran, lived in Spain until her late teens, moved to Sherbrooke, Que., with her family, and got a PhD at Laval, a post-doc at Yale, and went to medical school at the University of Montreal.

“Every case, concussion, CTE. Some of them also have spinal cord involvement. But that doesn’t define susceptibility, it doesn’t define how, the mechanism. Our goal is to see what else, and check the hypotheses that we have. I cannot base that on 10 (football) brains.”

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She has a hypothesis. From what Dr. Hazrati has been able to discern, brain trauma may cause inflammation in the brain, which releases a cerebrospinal fluid called ATP. That ATP binds to receptors, and the end result is the tau proteins, which constitute part of the natural structure of the brain, end up pooling all over, killing neurons and blood cells, impairing brain function.

The trauma leads to men who forget things, who become too angry, who literally lose their minds. The slides Hazrati has, and McKee has, are only posthumous waypoints in the disease.

“This is the end,” Dr. Hazrati says, pointing to a series of slides from ex-CFL players, whose brains have been visibly deformed. “The fire has been put to the forest, it has burned down, and now try to figure out what type of match they used to start the fire. So we need a lot of donors, and each piece is going to give us a part of the story. Right now, we are looking through a keyhole, all of us.”

The best-case scenario is this: a test for CTE in living brains. (The test announced by UCLA last year uses what Dr. Tator describes as an unreliable tracer, and as he says, “You shouldn’t have to die to get a diagnosis.”) Then a way to block the receptors from activating due to the ATP. Calm the brain inflammation before the forest burns down.

It’s only a theory, which she has attempted to test in mice. They will need more human brains that have been exposed to significant trauma — CFL players, in other words — to fully break down the process. Hazrati and Tator admit they are more careful about CTE than the Boston group, because so little has been proven other than its existence, its link to football and its end-game effects. Hazrati points to the NHL player’s slide again.

“CTE exists, despite the fact that there is very little of that brown,” she says. “It became debilitating. He was young. So the question is, how would this guy have progressed? Would it be more of this? Would he progress to having more a mixed progress? Or would he have just had Alzheimer’s? Would he have progressed at all?”

Nobody knows, because the young man died, his mind disappearing. In this little office next to the autopsy room, they would like to find more pieces of the map.

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